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Dr. Susan Rubin on What You Might Not Know About Multiple Sclerosis

Friday, February 23, 2018 8:11 AM

Multiple sclerosis (MS) is one of the most common neurological disorders in America, but many do not know how to recognize the symptoms, what causes it, or that it can appear alongside other conditions. Dr. Susan RubinNorthShore Neurologist, shares some need-to-know information about MS, and what NorthShore is doing to better the treatment process.

What is multiple sclerosis? 
Multiple Sclerosis is an inflammatory and degenerative disease of the central nervous system (brain and spinal cord) leading to loss of the myelin covering of nerves and eventually damage to the nerves themselves. Most patients with multiple sclerosis have a relapsing remitting course which means they will have periods where they develop new symptoms and then periods where they have recovered from those new symptoms and are stable. Unfortunately over time the ability of the nervous system to recover from new symptoms becomes less effective and patients are left with residual symptoms. Disability builds as the number of residual symptoms builds. Rarely patients have a progressive course from the beginning and develop progressive disability over time without a distinct onset of new symptoms.

What are some of the recognizable symptoms of MS? 
Multiple sclerosis can affect any part of the central nervous system and the symptoms relate to where the inflammation is occurring. Some of the most common symptoms of Multiple Sclerosis include inflammation of the optic nerve leading to vision loss (optic neuritis), inflammation in the spinal cord or brain leading to numbness, weakness, incoordination, bowel and bladder control issues and excessive fatigue.

Is MS curable? 
Unfortunately we do not have a cure for multiple sclerosis yet but we can reduce the effects of the disease by reducing the frequency of new symptoms.

What does the current treatment process involve? 
Treatment is divided into two main paths which are often used together to manage the patients. The first is symptom management and we can prescribe many different medications or therapies to help alleviate acute symptoms (often by prescribing anti-inflammatory medications like steroids) as well as control residual symptoms (with medications, physical therapy, lifestyle modification, etc). The other path is disease modification by prescribing a medication to alter the course of the disease and reduce the likelihood of new symptoms. We are fortunately to now have 14 different treatment options so we can tailor the treatment to the patients’ needs and preferences. All of these treatment options are available through NorthShore and all of our MS specialists are comfortable with providing these treatments. 

Some women are diagnosed with MS after pregnancy – is there a reason it appears at this time? 
Sex hormones do have an impact on multiple sclerosis and pregnancy is often a time of reduced disease activity as estrogen and progesterone levels rise. However in the postpartum period after delivery patients often have an increased risk of disease activity as the hormone levels shift down again. Furthermore, stress can impact disease activity as well making the postpartum period the common time for a first symptom or a new event in an already diagnosed patient.

How does patient care for MS patients differ for those who have had recently had a baby? 
As mentioned above, pregnancy is often a time where there is little activity so patients often come off their disease modifying medications during pregnancy. The decision then needs to be made whether a patient should go back on medication during that riskier postpartum period. If the mother wants to breast feed we don’t recommend being on their disease modifying medication so we need to provide other methods of decreasing risk like intermittent doses of steroid medications or IVIG to help prevent new symptoms while they are breast feeding.

Are there any signs pregnant women should look out for that might indicate MS? 
There are no signs that someone might develop MS after their pregnancy. In fact they often feel great during pregnancy even if they have been diagnosed with the disease previously.

Is there any research/clinical trials being done focusing on MS? Any new treatment options/medications that are being integrated at NorthShore? 
Fortunately there is a lot of research being done focusing on MS looking for better medications to manage the disease, alternative or lifestyle modifications that could more naturally help treat or prevent the disease and research into possible causes that might lead to a cure. At NorthShore we are involved in new drug trials as well as our own research to look for genes that might be involved in the disease. A majority of our patients are entered (anonymously) into a database that helps us better understand the disease course, treatment effectiveness and factors that impact management. Blood samples are also collected and sent for genetic analysis to hopefully identify possible causes of this disease.